Behavioral health consultation now available in primary care clinics

By Staff Sgt. Devon Suits, Air Force News Service / Published May 21, 2014

JOINT BASE SAN ANTONIO – LACKLAND (AFNS) --

Airmen, dependents and veterans now have access to behavioral health services through their primary care manager, or PCM, at any military treatment facility, Air Force Medical Operations Agency officials report.

The Behavioral Health Optimization Program, or BHOP, was developed to employ internal behavioral health consultants, or IBHCs, psychologists and social workers, into primary care clinics, said Maj. Matthew Nielsen, the chief of BHOP.

“The program helps to fight the mental health stigma,” he said. “A lot of patients aren’t willing to go to the mental health clinic, but a lot of people are willing to discuss their concerns during primary care visits.” In fact, research suggests that more than 50% of all behavioral health disorders are treated in primary care exclusively and 67% of people who may have behavioral health problems do not get treatment at all.

“Research has demonstrated that BHOP is a very effective model and we are seeing a lot of patients in primary care,” he said. “Patients are getting better and they report being highly satisfied with these services.”

According to Nielsen, the implementation of BHOP into treatment facilities was not created to eliminate the need for mental health clinics. The program operates on a separate model providing what he refers to as a “stepped-care approach.”

“We don’t consider BHOP to be mental health treatment or psychotherapy,” he said. "We don’t go into the amount of detail and depth (of treatment) that mental health clinics do. It is a different standard of care. We focus on behaviors, habits and things you can do right here and now to improve whatever symptom or condition you are experiencing.”

Some of the major conditions the BHOP program provides services for are: depression, anxiety, panic disorder, tobacco use, alcohol misuse, diabetes, obesity, insomnia and chronic pain.

“BHOP is a brief intervention model,” Nielsen said. “We see patients three to four times, and our appointments are typically 20-30 minutes long. If you need help beyond that, the IBHCs will place a referral for the patient to go to a mental health clinic, either on base or in the community.

“We don’t believe that all patients require the intensity and level of care that mental health clinics provide,” he said. “Research has demonstrated that many patients can make significant improvements within this brief model of primary care behavioral health. “

This summer, BHOP is also launching a one year pilot project in four military treatment facilities that will require active duty members to go through their PCM and BHOP before getting referred to a mental health clinic. If the pilot project is successful, it would be rolled out Air Force-wide.

Though much of the focus of the program has historically been placed on the PCMs and the IBHCs, Nielsen says the program also now incorporates nurses, also known as behavioral health care facilitators (BHCFs), to help facilitate care for patients who are treated with medications for specific mental health conditions like depression, anxiety or PTSD.

“If a PCM prescribes medication for depression, anxiety or PTSD, then the BHOP nurse will contact the patient via the phone, once a month, just to check on them to see how they are doing, if they are experiencing any side effects, and to assist them in scheduling PCM follow up appointments as necessary,” Nielsen said.

“We have found this to be an effective model as research has proven patients’ symptoms improve more rapidly when someone contacts them regularly throughout the treatment process,” he said. “Also, patients really like that contact because they feel like, ‘the team really does care about me,’ while helping them access resources they need, as they need them.”

BHOP was created in 1997 as an Air Force pilot program and received limited funding in 2008, Nielsen said. In fiscal year 2012, the program was implemented across the DOD and has proven to be an effective model of treatment and has already seen a lot of success.

“Airmen and commanders should know that this is another resource for them to access behavioral health care. The program provides behavioral support for all kinds of conditions,” he said. “Airmen and their families just need to drop in and ask their PCM about it.”